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� �; — — �� - i � � � ;� � <br />� '� _ — _ :: _ <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everetfwa.gov/permits <br />PIZOJECT SITE I�IFORMATION <br />PROJECT ADDRESS: 7j � <br />IF APPLICABLE: ❑ OUTSIDE CITY LIMITS ❑ BUILDING AREA SF ❑ LOT # <br />BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-# OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL <br />CHANGE OF USE? ❑ NO ❑ YES, FROM TO <br />UTILITY APPL.ICATION INFORMATION <br />SEWER (check all that apply) WATER (check all that apply) <br />❑ SIDE SEWER REPAIR ❑ NEW WATER SERVICE INSTALLATION <br />❑ 51DE SEWER ALTERATION ❑ COMPLETE SERVICE ❑ METER ONLY <br />❑ NEW SIDE SEWER INSTALLATION SERVICE / METER USE: <br />� WSTALL BACKWATER VALVE (outside the building) ❑ SFR <br />❑ SIDE SEWER CAP-OFF ❑ MULTI-FAMILY -# OF UNITS: <br />❑ SIDE SEWER RECONNECTION ❑ COMMERCIAL <br />Mt1l.T1PLE L�OPJIFSTIC VVATER SFR��ICES REC1UEST VUATER SERVICE TYPE / SIZE: (circle desired siz_e) <br />❑ I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR ❑ DOMESTIC: 3/4", 1", 2", OTHER: <br />MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. ❑ �RRIGATION: 3/4", 1", 2", OTHER: <br />❑ I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER ❑ FIRE: 1", 2", 4", 6", 8", OTHER: <br />SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER ❑ DOMESTIC/F1RE COMBO: 1", 2", OTHER: <br />SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. <br />14 Water and Sewer or such other rules and regulations now exrsfing or which may be established from time to <br />fime. The applicanf further agrees, as a condition precedent to receiving service fhat the utilities division shall have <br />the righf at any time, without notice, to shut o!f or turn on ihe water supply fo� �epairs, construction, and <br />nonpayment of charges orfor any otl�erreasonable cause. 1 am the owner, orl am authorized by the owne�of this <br />property fo perform fhe work fo� which application rs made, and I comply with the State Contracfors Law 18.27 <br />RCW nd 296.?_O�A WAC. ' � <br />r j � <br />I� �;�w ��°� � � 6��'�-``� �1; ��������� � � ►� ��,� I N.,� <br />�� �� <br />Agent Signature <br />FEE �� <br />� �� ���1 <br />.� <br />PERMIT # <br />� � '� ' <br />1,�. <br />(Revised 10/12/2015) <br />